Hard work takes its toll

As overtime increases, so does hypertension risk. Let's hear it for the 40-hour workweek.

Ponder this as you enjoy -- if you enjoy -- a few extra hours of leisure this Labor Day: Workers may be a nation's lifeblood, but when too many work too much, the nation's blood pressure will rise.

Combing through a survey of Californians, researchers at UC Irvine have established a long-suspected link between work and health in America -- that people who put in long hours on the job are more likely to suffer from hypertension than those who work less. Add that finding to recent studies demonstrating that employees working overtime are far more likely to get sick or injured, that their rates of sudden cardiac arrest are higher and that women who put in longer work weeks smoke more, snack more and exercise less.

All told, the findings are enough to suggest that good hard labor may be a prescription for very poor health. Now that the average American workweek has climbed to the top of the industrialized world, our devotion to work could cost us, big time.

"Americans work really long, and we know this trend hasn't been getting better, it's been getting worse," says UCLA Public Health School Dean Linda Rosenstock, who directed the Labor Department's National Institute for Occupational Safety and Health from 1994 to 2000. "It portends a bigger health burden down the line," she adds, and that will swell the nation's $2-trillion expenditure on healthcare.

The latest bad news for workaholics comes from a study, published in the October issue of the American Heart Assn.'s journal Hypertension, that looked at the survey responses of 24,205 working California adults in 2001. Compared with employees in the state who worked fewer than 40 hours a week, workers who clocked more than 51 hours on the job were 29% more likely to have diagnosed high blood pressure. Even just a few hours of overtime -- between 41 and 50 hours of labor a week -- increased the risk of high blood pressure by 14%.

"Each step up increased the risk of having hypertension," says Dr. Dean Baker, a study author and director of UC Irvine's Center for Occupational and Environmental Health. "It wasn't like you have to work a very high number of hours for this effect to occur."

Among working Californians, overwork is hardly rare either, he adds. About 18% of those surveyed said they worked more than 50 hours a week.

To doctors and public health officials intent on finding and treating the millions of Americans with undiagnosed high blood pressure, the study provides an important new clue. A patient's long work hours are as powerful a predictor of high blood pressure, they now know, as being male or being poor -- both of which are significant and well-established risk factors.

The new study also found that clerical and unskilled workers had far higher rates of diagnosed hypertension -- 23% and 50%, respectively -- than did professionals, even when employees worked the same number of hours. That result, which is in line with established research, suggests that work that gives employees more control over their working conditions and greater mental challenges may have a protective effect against hypertension, say authors of the study.

These findings, Baker says, suggest that physicians should routinely ask adult patients about how much they work, and in what kinds of jobs, as a means of identifying those at higher risk for hypertension. But as the average American workweek creeps upward, the findings also should guide employers and workers in deciding when demanding more or working more becomes too costly.

"It's important for individuals, as they go through their work careers, to be aware there may be adverse effects on their health" from lengthy workweeks, Baker says. "And employers should be aware that if they establish policies that require or encourage people to work long work hours, it may result in higher medical-care costs."

In Asia, long work hours and high job stress have become so pervasive that employees have a name for the phenomenon of death from overwork. One researcher concluded that, in Japan, karoshi may claim the lives of up to 10,000 workers a year. In China, though there is no official count, the number of guolaosi victims is said to be growing as fast as the nation's economy.

A welter of studies on Asian and European workers have linked excessive work hours to increased risk of conditions such as heart disease, sudden heart attack, high blood pressure and depression, as well as habits such as smoking, poor diet and sedentary lifestyle. But in the United States, the health consequences of chronic overwork is a subject largely ignored by American researchers and employers and by workers themselves, who either have too much of a can-do mind-set to admit the problem or are too tired to care.